Has anyone had their cervical fusion not fuse and not have to have a 2nd surgery? My c 5-6-7 was done and I am in constant pain, osteoarthritis is progressing to all my joints. I'm wondering if taking out the hardware and letting my body heal without disc replacement is possible? Waiting for a call from a new neuro to start all over again?

Cardinal
Hi, I had an ACDF on C5,6&7 on Nov. 29/03 and did not get any relief at all from the pain. I was back in for several check ups with the neurosurgeon (I had a car accident (whiplash - not my fault) 6 weeks after surgery and the surgeon saw me that night in the hospital and said that my pins and plates looked good and that nothing had moved. I went to see him several times after that as I was still in so much pain. At 4 months he told me that he couldn't help me and that he was afraid that I had "Fibromyalgia". At 14 months after so many treatments and therapies and injections in between I went back to him and begged him to help me. He "then" sent me finally for a myelogram which showed him that C3&4 for were degenerating and he offered to extend the plate in my neck to include those vertabrae but said he would do the myelogram and get the results first. After getting the results he called me to say that I hadn't fused on C6&7 that my donor bone had disintegrated and he didn't know why. On the phone he offered me more surgery and said that he would take out the existing hardware and put in a metal cage this time with my own bone from my hip. I made an appt. for a consult and when I went in I questioned him why he hadn't sent me before 14 months to see if I had fused or not and he said that I didn't fit the profile for a non-fusion and I asked him what the symptoms would be for a non-fusion and he said "NECK PAIN"!!!! I have had nothing but neck pain and he knows it. My husband and my son were with my and we all just gasped at disbelief because he knows how much pain I am in.I asked him a few more questions that he didn't like and he proceeded to tell me that he couldn't help me to go to another doctor. He basically said he didn't like our line of questioning and he didn't want to be my doctor anymore!!!! I didn't realize that you weren't allowed to ask questions about your life!!!! Anyway before he kicked me out he told me that even though the donor bone had disintegrated that my neck was still very stable because the plate was still in place and it didn't matter that I hadn't fused. He offered me two different surgeries in two days and because I questioned him he told me he couldn't help me. How frustrating!!!!!!.
The pain management doc has sent me for medial branch blocks which are injections into C3,4&5 which are only diagnostic. He thinks the pain could be myofascial and these injections were put into my facet joints. The freezing comes out in about an hour but if you get some relief approx. 50-60% then he said that I would be a good candidate for burning of the nerves under radio frequency. Well I got some relief about 60% the first time and then they did it again about a week later and I got about 50% so I have an appt. to have my facet nerves burnt, youuucchh!!! This only masks the pain and it could last anywhere from 6months to a year so I am willing to try it. They only do one side at a time so it takes quite awhile for the whole procedure to get done.
What does your doctor say that he is going to do with your case? I am very interested. Sorry for venting, I am so sick of listening to myself but pain can be very upsetting and depressing when it goes on so long, I am sure you will agree with that.
Talk to you again soon.
Take care of yourself
Lyn in Michigan

I had ACDF with cage on levels C4-C7 in Oct. 03. I had a Posterior fusion with rods and screws on levels C3-C7 in Feb. 05 to correct the failed ACDF. The ACDF surgeries have a higher fail rate, but the doctors won't tell you that.

Oh Lyn and Monty we share so much! Good article Monty!! scares me though. So now what do we do? I am in so much pain and don't know where to turn? What do I do? I have no fusion, osteoarthritis is getting horrible!! Do you really think posterior is better? Should I go with my own bone this time? I wish we could actually "talk" with a doctor we could TRUST! My whole back is ddd, l3-5 herniated, c 5-6-7 non fusion and c 3-5 bulging. I'm really getting scared!!!!!

I had ACDF with cage on levels C4-C7 in Oct. 03. I had a Posterior fusion with rods and screws on levels C3-C7 in Feb. 05 to correct the failed ACDF. The ACDF surgeries have a higher fail rate, but the doctors won't tell you that.

The Posterior approach used to be the norm for cervical surgery until ACDF was developed. ACDF is a less invasive surgery and easier to sell to the paitent. I think the Posterior approach is better because they use it to correct failed ACDF surgeries or when they feel an ACDF isn't going to help. As for how I feel. I still have issues with the herniations in my Thoracic spine and I have much pain from the nerve that was severed during my TransThoracic Surgery I had a year ago. My neck is healing nicely but I will always have pain.

Hi Monty! I thought the reason they did anterior is bettter able to get to the area? Is posterior harder to heal? being on your back and all? It seems like the better approach, being that it is closer to the area? Also, do you have any swallowing problems like anterior causes? Did they take out all the old hardware and replace?

The Posterior surgery is more involved as neck muscles are pulled away and must be stitched back in place. The recovery is longer and post op pain is higher. The incision is longer and takes longer to heal also. This is why surgeons choose the Anterior approach. Although, there are no swallowing problems caused by a Posterior approach either. In my case, they left all the existing hardware in the front and added hardware to the rear. The x-rays are quite impressive! Also, another level had collapsed after the ACDF, so another level had to be included in the Posterior fusion. The Posterior fusion is considered to be more stable than a frontal approach.

The Posterior surgery is more involved as neck muscles are pulled away and must be stitched back in place. The recovery is longer and post op pain is higher. The incision is longer and takes longer to heal also. This is why surgeons choose the Anterior approach. Although, there are no swallowing problems caused by a Posterior approach either. In my case, they left all the existing hardware in the front and added hardware to the rear. The x-rays are quite impressive! Also, another level had collapsed after the ACDF, so another level had to be included in the Posterior fusion. The Posterior fusion is considered to be more stable than a frontal approach.

Oh boy, can't wait, lol. Yes, me too, just the regular x-ray I just had shows c3-7 a mess, so can imagine what the mri will show. Sounds like I will have some "add ons" too. At this point "bring it on" I am not living like this. Gosh, just to imagine feeling good and able to do just simple things would be a blessing. Thank God for this board, I am not alone.

I had an anterior cervical fusion 4 years ago to fuse 2 levels. I had one level already fused from birth. The Dr used bone from my hip for the graft and placed a plate and screws to hold it all together. Levels 3-6. I had pain and numbness off and on for the last 4 years. I cannot do much at all physically or I will suffer for days. I have had PT 4 different times to try and improve my strength and lessen the pain. I have had several X-rays, etc. I recently had a MRI and my Doctor found the problem. I never healed from the fusion. The lower level never fused. It's all held together with the plate and screws, but there is still movement. I had posterior fusion March 31st. Since my neck is deformed from birth the doctor did not know what he was going to do once he got in there. I have not had a chance to speak to him without the benefit of drugs so I am lacking on the details but he used my bone and fused and wired the 3 levels from the back. The x-rays are impressive my brother thought I had enough metal to build a bridge! It's too soon to say if it all has solved my problems but I feel pretty good today. I asked my doctor why the first fusion on level 5-6 never healed and he was not sure of any answer that would be completely correct. He had discussed the case with his partners and he seemed almost as dissapointed as me. There are too many things that can go wrong, bone, general health, etc. In multiple fusions the lower level has a greater chance of failure due to the stress placed on it from above. I wish we knew exactly what our chances were prior to surgery. I can't help you with your question about removing the hardware. I know that it can be done but I do not know of any benefits. Good luck and the best thing you can do is find a doctor you trust and that will answer all your questions.

Cardinal,
Sounds like you're going through the same process I went through. I had a two level acdf (C5-7). After initially feeling great post op I started to get increasing pain which was ignored by my surgeon and did not respond to PT etc. Also got weakness in one arm and hand which had initially improved after the first surgery.

Finally got a CAT scan which showed both levels had failed to fuse, one more so than the other. Got several opinions all of which said that further surgery was inevitable at some point, when to do it was up to me. My options were to go in through the front again or do a posterior fusion and instrumentation. I was also told that although the posterior approach involved a prolonged recuperation period it was more likely to be successful.

Five months ago I had the surgery and have only just now returned full time to work, was part time after four months. So far have been doing well, am being very cautious and not pushing things. Have also a great physical therapist who is monitoring my progress and knows when to hold me back.

Let us know what the new neuro recommends, can't tell you how important it is to get multiple opinions and then decide what to do. Go with the surgeon you feel most comfortable with and who is able to take the time to answer your questions and explain all your options.

Good luck, it's rough at the moment but I have no regrets about proceeding with the second operation, tough though it was.
W

Thanks Wi.! That is encouraging to know you are doing so well!!! I'm just concerned now that my lumbar is not getting better on top of the cervical stuff. My whole back is deteriated, so many issues for them to work on. Got to get the mri asap and go from there. Today is not a good day for me, can't stand up, haven't had one of these episodes since prior to my lumbar surgery.

Cardinal
Hang in there, I understand the misery you're going through. I've been trying to ignore the fact that my lower back problem causes severe leg pain that wakes me most nights, usually with a nightmare that I'm having a surgical procedure on my leg with no anesthesia! At least, unlike you, things are not progressing.

Regarding ADR for your lumbar spine - I understand that now the Charite has been approved for the US a core group of spinal surgeons are using it. As far as I understand it is good for single level lumbar problems but if you have additional problems such as stenosis, foraminal probls etc it might not be appropriate. So before rushing to Germany check it out here. One of the big things that has slowed down ADR is insurance approval, given its cost many insurance companies are hesitant to approve it.

Let us know what transpires. BTW in addition to MRIs you might want to see if you need a CAT scan, that's what showed my non fusion and also the boney problems that followed.

Thanks W! I've booked my mri for this Friday, both cervical and lumbar with contrast. My reg doc office did not want me to go to the hospital mri, as they have their own mri's there. Its all about "money", I am sticking to ther better equipment at the hospital!! Plus my own doc tried to charge almost double for the mri!! Because I must pay cash, I got a discount. I think the mri's show the most and tend to be best and accurate. So guess I will wait to see results and then proceed, if I can wait til August I will be insured! The new neuro sd they won't do both levels, cervical and lumbar at the same time, too risky. Just gotta wait to see the mri and go from there, oh boy stress is so high right now. It is all about money and insurance, so sad. I could start a rampage on the healthcare system but I better not get started, lol. Plus I signed off on my ltd settlement, boy was that a mistake!

Good for you, stick with the better facilities, will save having scans redone if you get another opinion. Also, as you are dealing with a failed cervical fusion make sure you have a recent CAT scan of the c-spine - that's what proved my symptoms to be real and not in need of a facet block as the original neurosurgeon thought. Let us know what transpires - hope you're getting other opinions especially contemplating more surgery.
W